姑息治疗中的癫痫发作管理：德国医生实践的探索性横断面调查。
Seizure Management in Palliative Care: An Exploratory Cross-sectional Survey of Physician Practices in Germany.
文献信息
| PMID | 42874890 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Dr Med Anna-Christin Willert |
| 作者单位 | Department of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health. Electronic address: anna-christin.willert@charite.de. |
| 期刊 | Journal of pain and symptom management |
| SCI 分区 | Q1 |
| IF | 4.3 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
背景： 癫痫发作对重症患者构成重大挑战，尤其是当意识改变或吞咽困难影响服用抗癫痫药物（ASM）的能力时。然而，用于指导姑息治疗中癫痫发作管理的证据有限。尽管已有针对癫痫人群的指南，但针对重症患者或临终患者的建议很少。
目的： 描述德国专科住院（SIPC）和门诊姑息治疗（SOPC）中的癫痫发作管理实践和ASM使用情况。
方法： 我们于2023年8月至2023年10月期间在德国姑息治疗医生中开展了一项探索性横断面在线调查。问卷涵盖关键领域，包括ASM选择、给药途径、急性癫痫发作治疗时机和方案、向苯二氮䓬类药物（BZD-ASM）的转换、ASM停药以及临床实践中遇到的挑战。
结果： 在111名参与的姑息治疗医生中，98%报告启动维持性ASM，最常见的是左乙拉西坦（98%）和咪达唑仑（75%）。大多数医生（99%）报告常规使用急救药物处理急性癫痫发作。咪达唑仑是最常报告的一线急救药物，在SIPC中53%的医生首选，在SOPC中65%的医生首选。对于癫痫持续状态的二线治疗，左乙拉西坦是SIPC中最常见的选择（50%），而咪达唑仑在SOPC中更受青睐（52%）。
结论： 德国姑息治疗中的癫痫发作管理反映了重症患者的特定需求，并部分偏离了既定的癫痫指南。研究结果指向向个体化方法的转变，包括优先使用BZD-ASM、灵活的给药途径以及增加超说明书用药。这凸显了在姑息治疗中制定量身定制指南和开展前瞻性研究的必要性。
英文摘要
CONTEXT: Seizures pose significant challenges in patients with serious illness, particularly when altered consciousness or dysphagia impair the ability to take antiseizure medication (ASM). However, evidence to inform seizure management in palliative care is limited. Although guidelines exist for epilepsy populations, recommendations for people with serious illness or the end of life are scarce.
OBJECTIVES: To characterize seizure management practices and use of ASM in specialized inpatient (SIPC) and outpatient palliative care (SOPC) in Germany.
METHODS: We conducted an exploratory cross-sectional online survey among palliative care physicians in Germany between 08/2023 and 10/2023. The questionnaire covered key domains, including ASM selection, routes of administration, timing and regimens of acute seizure treatment, transition to benzodiazepines (BZD-ASM), ASM discontinuation, and challenges encountered in clinical practice.
RESULTS: Among the 111 participating palliative care physicians, 98% reported initiating maintenance ASM, most commonly Levetiracetam (98%) and Midazolam (75%). Most physicians (99%) reported routinely using rescue medication for acute seizures. Midazolam was the most frequently reported first-line rescue medication, preferred in SIPC by 53% and in SOPC by 65%. For second-line treatment of status epilepticus, Levetiracetam was the most frequent choice in SIPC (50%), while Midazolam was preferred in SOPC (52%).
CONCLUSION: Seizure management in palliative care in Germany reflects the specific requirements of patients with serious illness and partly deviates from established epilepsy guidelines. Findings point to a shift towards individualized approaches, including prioritization of BZD-ASM, flexible routes of administration, and increased off-label use. This highlights the need for tailored guidelines and prospective research in palliative care.